| ObjectiveAnalyzing the dynamic contrast enhanced magnetic resonance imaging characteristics,time-signal intensity curves,quantitative parameters,apparent diffusion coefficient and intravoxel incoherent motion parameters of different molecular classification of breast cancer,to explore the relevance of quantitative DCE-MRI and IVIM parameters with biological indicators of estrogen receptor,progesterone receptor and human epidermal growth factor receptor-2,Ki-67.And to assess the diagnosis efficiency of different molecular classification of breast cancer on the combination of quantitative DCE-MRI and IVIM parameters.Materials and methods65 female patients with breast cancer who successfully completed breast MR examination after mammography or breast ultrasound examination in the first affiliated hospital of Dalian Medical University from April 2014 to December 2016 were collected,while 46 patients were enrolled into the study(49 lesions).All lesions confirmed by surgery pathology underwent immunohistochemical analysis and denied biopsy,chemotherapy,radiotherapy before MR examination.The age of patients ranged from 28 to74,the average age was(50.02 ± 10.89).GE 3.0 T MRI scanner and 8 channel dedicated bilateral breast phased coil were used.Routine MRI scan sequences include axial T2 STIR sequence and sagittal T2 FSE FatSat sequence.DWI scan sequences include single b value(1000s/mm2)and multiple b value of DWI(IVIM)FSE sequence.3D dynamic enhanced scan was made with using of the VIBRANT technology after plain scan.All images were processed with GE ADW 4.6 workstation.Analyzing the DCE-MRI imaging features,time-signal intensity curves and quantitative dynamic enhancement parameters of breast cancer,measuring the apparent diffusion coefficient values of DWI,pure diffusion coefficient values,perfusion diffusion coefficient values and the perfusion fraction values.The expression of molecular biology index of ER,PR,HER-2 and Ki-67 were recorded.Using SPSS 20.0 software to statistical analysis,the non-parametric test of Spearman method was used to evaluate the relevance of DCE-MRI features,TIC,quantitative parameters,ADC values,IVIM parameters of breast cancer with molecular biology index expression.Using Kruskal Wallis H-test to compare different molecular classification of breast cancer of DCE-MRI quantitative parameters,ADC values and IVIM parameters.The difference was statistically significant while P<0.05.ROC curve was used to evaluate the diagnosis efficiency of different molecular classification of breast cancer on the combination of quantitative DCE-MRI and IVIM parameters.Results1.The shape,edge of mass had no correlation with ER,PR,HER-2,Ki-67 positive expression(P>0.05).The internal enhancement features were negatively correlated with ER positive expression(r value was 0.387,P<0.05),while having no obvious correlation with positive expression of PR,HER-2,Ki-67(r value was respectively 0.205,0.205,0.04,P>0.05).TIC type was positively correlated with positive expression of Ki-67(r value was 0.318,P<0.05),while having no obvious correlation with positive expression of ER,PR,HER-2(r value was respectively 0.023,0.023,0.038,P>0.05).2.Ktrans values were negatively correlated with ER positive expression(r value was 0.353,P<0.05),while having no obvious correlation with positive expression of PR,HER-2,Ki-67(r value was respectively 0.333,0.23,0.333,P>0.05).Kep values were negatively correlated with ER and PR positive expression(r value was respectively 0.314,0.314,P<0.05),while having no obvious correlation with positive expression of HER-2,Ki-67(r value was respectively 0.272,0.272,P>0.05).Ve values had no obvious correlation with positive expression of ER,PR,HER-2 and Ki-67(r value was respectively 0.135,0.135,0.173,0.067,P>0.05).The median(interquartile range)of Ktrans values of Luminal A,Luminal B subtype,HER-2 enriched subtype and TNBC were respectively 0.137/min(0.041/min),0.175/min(0.061/min),0.196/min(0.023/min),0.186/min(0.017/min).The difference of Ktrans values between Luminal A subtype and HER-2 enriched type,between Luminal B type and HER-2 enriched type were statistically significant(Z value was respectively 2.192,2.192,P<0.05).The median(interquartile range)of Kep value of Luminal A,Luminal B subtype,HER-2 enriched type and TNBC was respectively 0.518/min(0.195/min),0.600/min(0.595/min),0.885/min(0.692/min),0.710/min(0.526/min).The difference of Kep value between Luminal A type and TNBC was statistically significant(Z value was 2.327,P<0.05).3.The ADC values were negatively correlated with ER and PR positive expression(r value was respectively 0.331,0.331,P<0.05).Having no obvious correlation with HER-2 and Ki-67 positive expression(r value was respectively 0.012,0.012,P>0.05).The Dslow values were negatively correlated with ER and PR positive expression(r value was respectively 0.416,0.416,P<0.05),having no obvious correlation with HER-2 and Ki-67 positive expression(r value was respectively 0.083,0.236,P>0.05).The Dfast values were negatively correlated with positive expression of ER,PR,Ki-67(r value was respectively 0.403,0.403,0.415,P<0.05),having no obvious correlation with HER-2 positive expression(r value was 0.226,P>0.226).The f values showed no obvious correlation with ER,PR,HER-2 and Ki-67 positive expression(r value was respectively 0.05,0.05,0.049,0.079,P>0.05).The median(interquartile range)of ADC values of Luminal A,Luminal B subtype,HER-2 enriched subtype and TNBC were respectively 1.10 x10-3 mm2/s(4.117×10-3 mm2/s),0.973 x10-3 mm2/s(0.218 × 10-3 mm2/s),1.07×10-3 mm2/s(0.200×1O-3 mm2/s),and 1.07 R10-3 mm2/s(0.261×10-3 mm2/s).The ADC values of Luminal B type were lower than HER-2 enriched type and TNBC ADC,the difference was statistically significant(P<0.05).The median(interquartile range)of Dsiow values of Luminal A,Luminal B subtype,HER-2 enriched subtype and TNBC were respectively 20.80×10-3 mm2/s,13.05 x10-3 mm2/s(4.15×10-3 mm2/s),15.60 ×10-3 mm2/s(7.40×10-3mm2/s),and 20.45×10-3 mm2/s(47.50×10-3 mm2/s).The Dfast values of Luminal A type were higher than that of Luminal B type,and the Dfast values of Luminal B type were lower than that of TNBC,the difference were statistically significant(P<0.05).4.In the diagnosis of Luminal B type,the area under the ROC curve of Ktrans,Kep,Ve,Dslow,Dfast and f values were respectively 0.406,0.497,0.423,0.353,0.157 and 0.462,indicating no actual diagnosis value of Luminal B type.In the diagnosis of HER-2 enriched subtype,the area under the ROC curve of Ktrans,Kep,Ve,Dsiow,Dfast and f values were respectively 0.642,0.537,0.589,0.674,0.589 and 0.747.According to the maximum Youden index,the best point of diagnostic of Ktrans,Kep,Ve,Dslow,Dfast,f values was respectively 0.1759/min,0.4515/min,0.182,0.4095 x10-3 mm2/s,11.15 x10-3 mm2/s and 0.453,and the diagnostic sensitivity were respectively 100%,100%,100%,80%,100%and 80%,diagnostic specificity were respectively 36.8%,21.1%,26.3%,57.9%,26.3%and 68.4%.In the diagnosis of TNBC,the area under the ROC curve of Ktrans,Kep,Ve,Dslow,Dfast and f values were respectively 0.685,0.546,0.560,0.708,0.741 and 0.296.According to the maximum Youden index,the best point of diagnostic of Ktrans,Kep,Ve,Dsiow,Dfast,f values was respectively 0.1775/min,1.041/min,0.2535,0.4095×10-3 mm2/s and 18.8 ×10-3 mm2/s,and the diagnostic sensitivity was respectively 100%,33.3%,83.3%,80%,83.3%,while the diagnosis specificity were respectively 50%,88.9%,50%,57.9%and 50%.5.In diagnosis of Luminal B subtype,the combined predicted ROC AUC was 0.853,and the diagnostic sensitivity,specificity were respectively 100%and 61.5%.In diagnosis of HER-2 enriched subtype,the combined predicted ROC AUC 0.684,and the diagnostic sensitivity,specificity were respectively 80%and 63.2%.The combined predicted ROC AUC of TNBC was 0.75,and the diagnostic sensitivity,specificity were 66.7%and 83.3%respectively.Conclusions1.The DCE-MRI enhancement,TIC type,Ktrans,Kep,ADC,Dslow,Dfast values of tumor were correlated with the molecular biology index.The Ktrans,Kep,Dfast values can be uesd to reflect the heterogeneity of different molecula-type breast cancer.2.Combined predicted Ktrans and Dfast for diagnosis:compared with a single index for the diagnosis,combined diagnostic efficiency of Luminal B type,HER-2 enriched typesignificantly and TNBC increased with the clinical diagnostic value. |
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